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Liver biopsy is the gold standard method to assess nonalcoholic steatohepatitis (NASH) resolution after therapeutic interventions. We developed and validated a simple and noninvasive scoring system to predict NASH resolution without fibrosis worsening after 1 year of lifestyle intervention. This was a prospective cohort study conducted in 261 patients with histologically proven NASH who were treated with lifestyle changes for 52 weeks and underwent a second liver biopsy to confirm NASH resolution. We divided the data into development (140 subjects) and validation (121 individuals) sets. NASH resolution occurred in 28% (derivation group) and 27% (validation group). At the multivariable analysis, weight loss (odds ratio [OR] 5 2.75, 95% confidence interval [CI] 1.65-4.58; P < 0.01), type 2 diabetes (OR 5 0.04, 95% CI 0.005-0.49; P 5 0.01), normal levels of alanine aminotransferase at the end of intervention (OR 5 9.84, 95% CI 2.21-44.1; P < 0.01), age (OR 5 0.89, 95% CI 0.83-0.97; P 5 0.01), and a nonalcoholic fatty liver activity score 5 (OR 5 0.08, 95% CI 0.01-0.43; P < 0.01) were independent predictors of NASH resolution. The area under the receiver operating characteristic curve of the selected model was 0.956 and 0.945 in the derivation and validation cohorts, respectively. Using a score threshold of 46.15, negative predictive values were 92% in the derivation and validation groups, respectively. By applying a cutoff 69.72, positive predictive values were 92% and 89% in the derivation and validation groups, respectively. Using both cutoffs, a liver biopsy would have been avoided in 229 (88%) of 261 patients, with a correct prediction in 209 (91%) Conclusions: A noninvasive prediction model including weight loss, type 2 diabetes, alanine aminotransferase normalization, age, and a nonalcoholic fatty liver activity score 5 may be useful to identify NASH resolution in patients under lifestyle intervention.

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